Medicare Fines as a Metric for Evaluating SNF Quality

When evaluating SNF quality, one health system resource is the Medicare Nursing Home Compare website, which includes information on the characteristics and quality of all 15,000+ Medicare-certified skilled nursing facilities in the country. Among the quality measures reported are CMPs, or Civil Monetary Penalties; when state survey agencies find that a SNF is noncompliant with health or fire standards set by CMS, the SNF may be charged a fine.

I recently worked on a project investigating the hypothesis that higher fines, as displayed on the Nursing Home Compare website, would be associated with a higher rehospitalization rate. In essence, we asked: do the CMP citations reflect nursing home quality?

Our findings may surprise you:

  1. Our hypothesis that higher fines would be associated with higher rehospitalization rates was incorrect. After adjusting for for-profit ownership, staffing and state, the total dollar amount of fines viewable on the Medicare Nursing Home Compare website explained only 7 percent of the variation in rehospitalization rate – not very much at all!
  2. The presence of recent fines, regardless of their amount, was associated with a higher rehospitalization rate. On average, SNFs that have a citation currently displayed on Nursing Home Compare have a rehospitalization rate that is 0.5 percentage-points higher than SNFs that do not have a citation. This relationship varies by state; a fine in some states is more indicative of poor quality than in other states.
  3. The takeaway: We think these findings are driven by the variation in the way state survey agencies conduct the surveys that serve as the basis for fines. Population health directors should know that CMPs are associated with higher rehospitalization rates, but that the dollar amount may not be meaningful and the relationship between fines and rehospitalization rate varies by state.

To increase referrals to high-quality post-acute providers, hospitals and health systems can leverage CarePort Guide. The tool provides detailed information on every Medicare-certified post-acute, home health and hospice agency nationwide. Compliant with discharge planning requirements as part of the IMPACT Act, CarePort Guide incorporates quality information and patient choice into the discharge planning process.

Contact us to learn more about CarePort Guide.

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